The Australian Dental Association’s Guidelines for Infection Prevention and Control describe the infection prevention and control procedures that dental practitioners and support staff are expected to follow.
This blog explores how the first two standard precautions – hand hygiene and personal protective equipment (PPE) – contribute to a safe environment for dental clinic employees and their patients
1. Hand Hygiene
Hand hygiene refers to processes that aim to prevent the transmission of microorganisms from the hands of dental staff to other staff and patients, or from one patient to another patient, either directly or by touching contaminated surfaces or objects.
In a dental setting, good hand hygiene involves either the use of:
- a TGA-approved hand wash or alcohol-based hand rub (ABHR), or
- a liquid soap solution and water, followed by patting dry with single-use linen or disposable paper towels.
Liquid soap and water, rather than an ABHR, must always be used in the following situations:
- at the start of a work session
- at the end of a work session, when leaving for a meal break, or at the end of the day
- after toilet breaks
- whenever hands are visibly soiled
When to perform hand hygiene
The Australian Dental Association (ADA) has identified 5 key moments for hand hygiene:
- Before touching a patient
- Before a procedure
- After a procedure or body fluid exposure risk
- After touching a patient
- After touching a patient’s belongings
2. Personal protective equipment (PPE)
Wearing protective clothing and equipment where splashes and aerosols are likely to be generated is an important way to reduce the risk of transmission of infectious agents.
Disposable gloves provide an essential layer of protection for dental clinicians to separate their skin from contact with patient fluids, mouth bacteria, and hazardous substances.
Glove materials vary in their resistance to chemical agents. Nitrile gloves have greater resistance to detergents, acids, and common organic solvents than latex gloves and are less likely to develop small tears and leaks during use.
Non-sterile gloves must conform to AS/NZS 4011:2014 Single-use examination gloves, and sterile gloves to AS/NZS 4179:2014 Single-use sterile rubber surgical gloves.
Masks protect the mucous membranes of the nose and mouth, and the skin of the face and neck. The ADA recommends that masks are worn at all times when treating patients. Masks must conform to AS/NZS 4381:2015 Single-use face masks for use in health care. Disposable surgical masks must have 98% or greater bacterial filtration efficiency and be splash-resistant.
Dental practices should observe the following mask protocols:
- Be put on before performing hand hygiene and donning gloves
- Be fitted and worn according to the instructions for use
- Cover the nose and mouth, and where possible, the chin and upper neck
- Be removed by touching the strings and loops only
Masks must not:
- Be touched by the hands while being worn, other than for removal
- Be lowered to expose the nose
- Be worn for longer than two hours
Dental practitioners and clinical support staff must wear protective eyewear to protect the mucous membranes of the eyes during procedures where there is the potential for penetrating injury or exposure to aerosols, splattering, or spraying with blood, saliva, or projectiles.
Safety glasses must be optically clear, anti-fog, distortion-free, and close-fitting, including shields at the sides.
Face shields are an alternative to protective eyewear that allow corrective glasses to be worn beneath. However, because face shields do not protect the wearer from inhaled microorganisms, they must be worn with a surgical mask.
Patients should be provided with protective eyewear to minimise the risk of injury during treatment. Patient eyewear can be either disposable or designed for reuse after thorough cleaning.
The most suitable type of protective clothing varies according to the nature of the procedure. Layering is crucial to ensure that street clothes do not become contaminated and transfer that contamination beyond the dental clinic. If scrubs are worn throughout the clinic, employees must wear a suitable layer of protective clothing on top of these, such as a gown. Alternatively, scrubs may be worn over a uniform or street clothes and removed before entering clean zones.
Disposable or washable gowns should be worn whenever splatter or aerosols are likely to be generated. Disposable gowns with long sleeves should be changed after each patient; reusable cloth gowns must be laundered or reprocessed according to AS/NZS4146:2000 Laundry Practice.
Dental workers should wear closed shoes that protect them from injury or contact with sharp objects. Footwear should be non-slip and easy to clean in the event of spills and splashes.
The remaining standard practices of infection control are covered in part 2 of this blog, which looks at surgical procedures and surgical aseptic technique, management of sharps and clinical waste, and environmental considerations.